Monthly Archives: July 2016

Police Entrapment, Terrorism and Wasted Resources

By Dr David Laing Dawson

Years ago a not-so-bright young man stole a Cadillac convertible. He had always wanted to ride in one, like a country and western star in a small town parade. This was the only way he imagined it could happen. The ensuing police chase, crash, lawyers, court appearances, sentencing was extremely costly. It would have been, I noticed at the time, much, much cheaper to buy him a Cadillac for a birthday present.

Another young woman had a penchant for setting fires. Whether she was in a jail, a hospital, or a boarding home. She was mentally ill, and we were trying to help her, but there was always a risk that her pyromania would cause many deaths as long as she was residing with others. Her care was costing the taxpayers in the neighbourhood of $200,000 per year. While in our institutions someone had to watch her at all times. A decent little house was selling for about $50,000 at the time. I proposed we buy her a detached house and take our services to her.

These two stories came to mind when I read about John Nuttall and Amanda Korody. It has been reported that the RCMP spent about $1,000,000 “entrapping” them.

Two marginalized people. Addicts. Neither bright nor sophisticated. Probably with their fair share of grievances and yearnings. Both destined to be burdens on the taxpayer for years to come. And both in that state of mind, that existential position, of searching for someone or something to blame and a way of elevating their sad lives.

Neither capable, on their own, of condensing those grievances into strategic action. Neither capable, on their own, of buying the ingredients and making a bomb, and successfully delivering it. Probably neither capable on their own of formulating a coherent argument why they should do this.

So, having discovered this despairing pair of hapless would-be terrorists, would it not have been much cheaper to give them a Lotto win of $100,000 and send them on their way. I know there is no sane way of doing that, but perhaps, instead of this elaborate sting operation, the RCMP could have alerted the local social services that this at risk couple needs extra help. Assign a new worker, a counselor to them. Review their needs, (social, educational, medical) and plan with them a better life.

So much less expensive and damaging and wasteful than all that police work, surveillance, subterfuge, and legal work, court costs.

Addiction services, psychiatric treatment, disability benefits, social housing, educational programs. These are all expensive. But so much cheaper than the alternative.

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On the Jail Sentence of Toronto Police Constable James Forcillo

By Dr David Laing Dawson

As much as I know the shooting death of Sammy Yatim was entirely unnecessary, and as much as I know by simply looking at pictures of Constable James Forcillo that he is pugnacious by nature and that his fear/aggression response is close to the surface, easily triggered, I still have qualms about his conviction and sentence.

We put the gun in his hand. We assigned him to that job.

And in doing so we made one of two mistakes. Either he and his fellow officers were not sufficiently trained and prepared, or wrongly trained and prepared, or he is not a man we should have put in that position in the first place.

If 99 out of 100 officers could have resolved that event peacefully, without anyone getting hurt, then Constable Forcillo should have been reassigned years ago. To a desk job, community liaison work, anything not requiring a gun.

If only 40 out of 100 officers could have resolved that event peacefully, without anyone getting hurt, then their training and supervision is wrong. Tragically wrong.

I know it can be a combination of both. But those are the two tools we have: Screen and monitor our officers for signs that their primitive fear/aggression response is dangerously close to ignition, and train, train, train them to react differently in those situations.

See previous blogs on police training at https://dawsonross.wordpress.com/2016/04/04/on-improving-police-confrontations-with-the-mentally-ill/ and https://dawsonross.wordpress.com/2016/04/04/on-improving-police-confrontations-with-the-mentally-ill/.

The Thin Veneer of Civilization – Another Plea for Gun Control

By Dr David Laing Dawson

It occurred to me watching the Republican Convention, the commentators who invoke Jesus and the latest cop shooting in Florida, that one of our problems is a persistent misunderstanding of human nature.

During my residency, my immediate boss, the Chief Resident, called me into his office one day to tear a strip off me, to berate me. He was a few inches shorter than I, a few pounds lighter. I was also more popular with the nurses and more likely to have influence on our ward. As he chastised me standing there I felt the Grey-Back Ape within awaken. My rat brain stirred. The image in my mind was clear. With little effort I could pick him up and throw him through the window onto the pavement two stories below.

I did restrain myself but that moment proved indelible. I am not being overly fanciful when I reference my rat brain or the Grey Back within, for it was, subjectively, a moment of being in touch with the lineage of my species, my DNA.

We were not created in God’s image. We were not born pure of heart. We are not all kind and good and righteous save for the “bad guys”. We are seldom entirely rational. We don’t even always act in our own best interest. No. For millions of years our families and our tribes fought and killed one another for food, and land, and water, and gold, and, sometimes, once we learned to speak and write, just for the stupid ideas being promoted by a charismatic leader. (which throughout history can be summarized in two phrases: We are the chosen ones; they are not.)  We also enslaved one another from time to time.

We fled central Africa and crossed the Sahara north, each defeated tribe having to move on to find another source of food and water. My own tribe, not so many years ago, was pushed off the arable lands of Scotland to the inhospitable rocks and fog of the Orkney Islands, and then had to trust the hold of a wooden ship to take them around the tip of South America to a new colony on Vancouver Island where they might find water and food and shelter again, after pushing a few Indians off the better land. Apparently the Indians called my great great great Uncle “Long Gun” which left us with a few adolescent opportunities for humor but which also means, I guess, that the laws permitted open carry at the time.

In many parts of the world we are no longer small tribes warring over food, land, water rights, and women of child-bearing age. We have, with some bumpy patches, accrued over the past 1000 years or so, a veneer of civilization. And, it is just that, a veneer that thickens at a snail’s pace, but can erode over night. It is a veneer based on a slowly evolved and very complex set of rules of governance, of laws and justice, of discourse, of conflict resolution, of inclusion. In this part of the world we live within a social contract very different from that of both our distant and more recent ancestors.

If we strip that veneer away I know that I will find inside myself the clansman who fought for sheep grazing pastures, the bitter Celt who was pushed off land by the Anglos, and was probably enslaved by the Romans, and ultimately the Patriarch in the jungle village fighting, and killing, for the survival of my cubs.

A year or so ago Vladimir Putin, the Alpha male in that particular jungle, roared aloud and pounded his chest. Throughout our particular jungle middle age male journalists and politicians stood up, roared aloud and pounded their chests in answer.

The fear-aggression response is close to the surface. Our veneer of civilization is thin and fragile.

We must do nothing to weaken it, for very quickly it can erode. And then the rat brain emerges and we once again live within a cycle of fear and aggression.

Inclusion, equality of income and opportunity, equality under the law, strengthens our thin layer of civility.

Donald Trump is doing his best to gouge holes in that veneer. If he succeeds the American tribe will have the Alpha Male it deserves.

But the other major threat to the American veneer of civilization is guns. The video from Miami makes that obvious. The boy or younger man is clearly impaired in some way, sitting obliviously, playing with a toy. The older man, lying in the most non-threatening posture it is possible to assume, is trying to explain the situation; the cops with weapons drawn and aimed, lurk behind poles and cars 50 feet away. The cops are in a state of arousal; they are alert, feeling threatened, fearful, and aggressive. The Grey Back Ape is stirring within each of them.

When I am pulled over for speeding I want that officer to approach my car certain, at least to a 99 per cent degree, that I will not be carrying a gun, and that I will certainly not have an automatic weapon or assault rifle. I do not want him approaching me in a fearful and hyper alert fashion. I do not want his primitive fear/aggression response triggered.

But it will be if he thinks I have a gun or even may have a gun.

So, my American friends, if you enjoy and appreciate the veneer of civilization within which you live, if you enjoy living in a land that is much safer than that of your recent ancestors, and many times safer than that of your distant ancestors, keep the guns in the stockade. By all means break then out and distribute them if you are actually invaded, but otherwise the only one in the crowd who should have a gun either concealed or open is a police officer.

Please, if everybody is carrying and a few, like Donald J Trump, are stirring up division and anger, you are risking that fragile veneer of civilization and a return to the tribal life of fear and aggression. And that, as we know, and have seen, can erupt in chaos and violence.

And then we will be saying, while watching videos of horror and killing, “They are animals!”, just as we say now watching some videos from the Middle East.

Donald J Trump and the Speech Patterns of 14 Year Olds

By Dr David Laing Dawson

When I was 16 I bought an LP of my favourite band with money earned at a Saturday job in a Sporting Goods store. I’m sure this purchase did not have a great impact on the music industry.

Today though, the taste and preferences of the 12 to 16 year old demographic does have impact on this industry, much to my chagrin.

George W. Bush tried to speak like an adult. He tried to use big words at times, and reasonable sentence structure. He tried even though he often made a mess of it, combining two words and inventing a third, missing the negative qualifiers and thus saying the opposite of what he meant, turning verbs into nouns, nouns into verbs.

Obama speaks as an adult, his considered words and good syntax presumably reflecting the manner in which he thinks.

The latter clause is an assumption but one we make of everyone with the exception of a liar: how we speak extemporaneously, off-the-cuff, is a pretty good indication of how we think. Not necessarily the content but at least the form, the logic or lack thereof, the coherence or lack there of, the consideration or lack thereof.

I am of course getting around to Donald J Trump. And there is a connection with my music industry comments at the beginning of this essay.

When he is speaking off-the-cuff (not reading from the tele-prompter) Mr. Trump speaks with the syntax, the semantics, the grammar, the choice of words, of a 14 year old. Actually when he is being positive he sounds like a 14 year old girl (randomly repeated superlatives, in random grammatical form), when negative, like a 14 year old boy (sputtered inconsiderate name calling and accusations).

The fact he speaks like this and therefore probably thinks like this is not the most puzzling fact. What is very puzzling to me is that a large American demographic now finds this acceptable, is not troubled by it, takes it in stride, even echoes it.

How did this happen? I’m sure they expected more from their presidential candidates through the last 100 years. Now, they can’t all be Winston Churchill or Pierre Elliot Trudeau, able to quote scholars and parse clever phrases on the run, but at least all presidential candidates spoke an adult form of English.

This leads to the depressing thought that the 12 to 16 year old demographic is influencing our speech, and how we hear ourselves, as well as our popular music. Suddenly they are, with our new technologies, dominating, by sheer volume, our written and spoken discourse. Their careless use of language (reflecting a careless way of thinking) may be influencing the older demographic to the extent that they find nothing unsettling in the thinking and speech of Donald J Trump.

They should. I know many 14 year olds. I do not want any one of them making decisions about anything beyond which instrument to play in the school band. No matter how many adult advisors Mr. Trump gathers around him, there will come a time he is on his own. In the job of president an inconsiderate, impulsive remark, or action, can have grave consequences for us all.

I bought that LP on my lunch hour and took it back to the Sporting Goods Store. The owner asked about it. I then told him, with the enthusiasm of a teenager, that this LP featured the best band that ever recorded music. I don’t remember exactly what I said. I may have used some Trump superlatives: “Big, Amazing, Wonderful”. But I do remember what my adult boss said. He said, “In your… very… limited… experience.”

Editor’s Note: Dr Dawson is a child and adolescent psychiatrist so has a great deal of experience with 14 year olds. He is also the author of The Adolescent Owner’s Manual.

Dallas, Baton Rouge and Untreated Mental Illness

By Dr David Laing Dawson

The two most recent mass killings in the US were murder suicides, in my opinion. The murder of police officers and the entirely predictable “suicide by cop” that quickly followed. There were previous incidents that provoked these acts and there certainly are contributing causal elements in the racial wounds of contemporary America.

And once again it is worth pointing out these two men had access to weapons any sensible country would restrict.

But this time each man exhibited signs of mental illness as well. I mention this because of the current controversies about anti-depressant medication mentioned in Marvin’s latest blog.

From what I have read about them I think both of these men would have benefited from treatment with antidepressants. Rather than causing violence this treatment may have prevented it. The ex marine who traveled from Kansas City to Baton Rouge may have benefited from anti-psychotic medication as well.

So while these incidents speak to the great divide in America today, to their insane gun laws, the social wounds that need to be addressed, they also speak to accessibility (or lack thereof) of mental health care, and by mental health care, I really mean psychiatric treatment for mental illness.

A Subjective Unscientific Analysis of Anti-Psychiatry Advocates

By Marvin Ross

Many of my Huffington Post Blogs attract some very nasty comments from the various anti-psychiatry adherents. The same applies to the blogs by my colleague Susan Inman and we get some on this blog. The Boston Globe award winning Spotlight Team featured in the film Spotlight, just did a series of articles on the sad state of mental health care in Massachusetts. Wanting to foster dialogue, they set up a Facebook Page for comments. And did they ever get comments!

I’ve been looking at more than my fair share of these comments over the years but decided to try to categorize them. So here goes.

1. I was badly treated, mistreated, misdiagnosed therefore all of psychiatry is evil. In some cases, this alleged mistreatment occurred over 50 years ago. I do believe that this happened in most cases and it should not have happened but it did. Personally, I’ve run into (or family members have) some very incompetent and inept treatment by doctors and/or hospitals. This has occurred in inpatient stays, visits to doctors or in emergency rooms. And some of these misadventures have been serious but I do not spend my time denouncing all hospitals, all doctors or all Emergency Rooms. What I have done is to complain to the appropriate authorities. And most of the time I’m successful.

As my English mom used to say, “don’t throw the baby out with the bathwater”

  2. The other very common cry is that I got help and recovered therefore everyone can recover and if they can’t, it is because the docs are bad or are trying to keep people sick to make money and peddle drugs. I’m sure there is an error term in logic where you extrapolate your particular situation to everyone. That is what these critics are doing. It is like saying I survived prostate cancer which has a 5 year survival of 98.8% so that someone with pancreatic cancer can too. Pancreatic cancer only  has a 4% 5 year survival rate. It is not the same nor is say mild anxiety comparable to treatment resistant schizophrenia. Stop mixing apples and oranges.

3. Involuntary treatment for those who are so sick that they pose a danger to themselves, others, or will deteriorate further without involuntary committal means that the state will lock up, drug and keep everyone indefinitely. None of these fears are true so learn what is entailed and get over it. And when I post a video or an article by someone like Erin Hawkes who went through about a dozen involuntary treatments till a pharmaceutical agent was found that removed her delusions, stop insulting her as some have done by calling her a victim and that she is suffering from Stockholm Syndrome.

How will you learn if you refuse to listen to other opinions?

What I suspect that these involuntary opponents do not understand is that people are not locked up without just cause or forever. There are safeguards in place to ensure regular reviews and appeals. In Ontario a few years ago, a group of so called psychiatric survivors challenged the constitutionality of community treatment orders and supplied the courts with affidavits from people who found them to be bad. This is what I wrote about that in the Huffington Post:

Justice Belobaba only had to look at the affidavit that the plaintiffs filed as part of their attack on CTOs to get an idea of how well they can work. Amy Ness had, prior to being put on a CTO, been involuntarily committed for showing violent behaviour in 2004. In 2007, while hospitalized, Ms. Ness kicked her mother in the back and hit her repeatedly. Then, in 2009, Ms. Ness grabbed a large kitchen knife and marched upstairs toward her mother after discovering a magazine about schizophrenia. In another incident, Ms. Ness kicked and punched the emergency department psychiatrist. By the time she was given a CTO in 2009, she had five hospitalizations.

Since then, while on a CTO, the judge pointed out, she takes her medication and sees her case worker on a regular basis. She has not been hospitalized, she maintains her housing and she works as a volunteer, has a job and takes courses. She does think, however, that the CTO is an attack on her personal dignity.

Herschel Hardin, a civil libertarian once wrote that:

“The opposition to involuntary committal and treatment betrays a profound misunderstanding of the principle of civil liberties. Medication can free victims from their illness – free them from the Bastille of their psychoses – and restore their dignity, their free will and the meaningful exercise of their liberties.”

A psychiatrist I know who is a libertarian (someone who believes that people should be allowed to do and say what they want without any interference from the government) told me that when your brain is immersed in psychoses, you are not capable of doing or saying what you want. Therefore, he was fully supportive of involuntary treatment so that people could get to the position where they had the capacity to do what they want.

4. And then we come to what Dr Joe Schwarcz on his radio show, Dr Joe, calls scientific illiteracy. He used that in his July 10 interview with my colleague, Dr Terry Polevoy, in a discussion on EM Power + and the conviction of the Stephans for failing to provide the necessities of life for their child who died of bacterial meningitis. They refused all conventional medical care, gave him vitamins, herbal products and echinacea till the poor little toddler stopped breathing.

There was a case of scientific illiteracy in that the parents are totally opposed to vaccinations and work for a  company that encourages people with mental illnesses to go off meds in favour of their proprietary vitamins. They had no idea why they were convicted, lashed out at the jury who convicted them and then, at their sentencing hearing, the wife shocked even her own lawyer when she told the court that the Crown had used a phony autopsy report as evidence.

Other examples are that anti-depressants cause violence and suicide. Violence possibly in those under 24 according to a large Swedish study but not in adults. However, the authors state that these findings need validation. There is no definitive proof of this and no evidence of increased violence in adults.

As for anti-depressants causing suicide, a warning that this might be a concern was posted on the labels. Doctors were advised to be cautious when prescribing these for depressed young people.Consequently, this resulted in an increase in suicide attempts.

“Evidence now shows that antidepressant prescription rates dropped precipitously beginning with the public health advisory in March 2004, which preceded the black box warning in October 2004. Since the initial public health advisory, antidepressant prescriptions for children and adolescents decreased, with a consequent increase (14%) in incidence of suicide in these populations.”

On my to-read list is Ordinarily Well The Case for Antidepressants by psychiatrist Peter D Kramer. Kramer is the author of Listening to Prozac and, in this new book, he continues with proof that antidepressants do work and are not simply placebos. Not only do they work, but they are life savers.

In the New York Times review by Scott Stossel, the reviewer points out that when Kramer first began visiting psychiatric wards in the 1970’s, they were filled with people suffering what was then known as “end-state depression”. These were depressed patients in what appeared to be psychotic catatonic states.

Patients like that have not been seen for decades which he attributes to the aggressive use of antidepressants.

And, lest we forget, there is also the common view that the chronicity of psychiatric disorders are caused by the drugs that doctors force on their patients. People love to quote the work of Martin Harrow in Chicago but I suspect that many have not actually read his studies. Some people, he found,  did better after going off anti-psychotics over time than those who continued with their use but that is not surprising. It has always been known that some people improve while others have chronic problems and still others are not able to be helped with anything.

What they do not realize is that in Harrow’s study, 79 per cent and 64 per cent of the patients were on medication at 10- and 15-year follow ups. And that Harrow points out that not all schizophrenia patients are alike and that one treatment fits all is “not consonant with the current data or with clinical experience.” His data suggests that there are unique differences in those who can go off medications compared to those who cannot. And he points out that it is not possible to predict who may be able to go off medication and those who need the long term treatment. Intensified research is needed.

So stop with the reference to Harrow that no one needs meds. And stop also with promoting Open Dialogue when, first, it has never been empirically validated and second, many of their patients are on medication.

5. Regrettably, many of these people lack any civility whatsoever. People are entitled to offer their comments but they should not do so anonymously. And they should show some respect for those who have different views. I’m told that some have been banned from the Spotlight Facebook page and I’ve just banned one anonymous person who posts here for his/her personal attacks. I mentioned above that Erin has been called a willing victim and one who suffers with the Stockholm syndrome for her video and her article. Refute the points she makes but leave the insults aside.

And, one post that I removed from the After Her Brain Broke page on Susan Inman in response to he video What Families Need From the Mental Health System claimed that Susan keeps her daughter locked up and ill and that she likely suffers from Munchausen by proxy.

 

Rehab and Drug Overdoses

By Dr David Laing Dawson

News item: Newly released inmates face higher risk of overdose death.

“The weeks immediately after release are a precarious time for former inmates. Job and housing prospects are usually bleak and drug tolerances are generally at a low point because of the relative scarcity of drugs in prison.”

This information is being used to support wider availability of the drug Naloxone, an antidote for opioid overdoses.

I am not opposed to the wider availability of Naloxone, but several things struck me about this report.

The first was the rather ambiguous statement about the “relative scarcity of drugs in prison.”

And the second was, “drug tolerances are generally at a low point.”

Yes.

And even with good jobs and excellent housing, every year a half dozen or so rock stars, musicians, actors, and other celebs die from overdoses of opioids. And always not long after a stint in rehab or otherwise imposed abstinence.

So while we need to do many things to help people with addictions, and help them survive and recover from those addictions, there is one very inexpensive and realistic thing we could do.

And that is tell, instruct, educate addicts when they are in jail, or in rehab programs that

  1. They are likely to relapse and
  2. When they relapse they will have lost their high tolerance to opioids, and the dose that previously gave them relief will now kill them. When they relapse they need to start with low doses, as if from the beginning of their use.

Maybe rehab programs already do this. I doubt it though, for it entails admitting probable failure.

If Philip Seymour Hoffman and Prince did not know this, how can we expect the average guy coming out of jail to know this?

This should be emblazoned on the walls of jails and rehab centers:

If you relapse, return to the same dealer, use the same dosage as before, it will now kill you.

Backlash, Change and Disruption

By Dr David Laing Dawson

How stupid can they be to vote to leave the EU? How stupid can they be to vote for Donald Trump?

These questions leap to mind but are mostly the product of bafflement, anger, and worry.

But perhaps we should take those two questions seriously and try to answer them. Because if we don’t understand these phenomena, we may find ourselves in big trouble.

Prior to the turn of the last century, as 2000 loomed, I wondered if there would be a backlash. That millennial year signified change and disruption, a world, yea a universe, that could no longer be understood using concepts and tools of the 20th century. It didn’t seem to happen at the turn of the millennium, but then we humans have a very narrow perspective. I think it is happening now, not all at once, but here and there, a growing backlash, a growing avoidance of the realities we face and the future that will unfold.

Historically it happened once before, thanks to the printing press. Suddenly knowledge was disseminated. Literacy grew. It was no longer locked away in the vaults of monks. The world was not flat after all. And the earth traveled around the sun, and even the sun was not the center of the universe. Humanism competed with religious dogma. Gallileo, Copernicus, Columbus, Da Vinci – they all had to be reckoned with. Maybe, just maybe, the Pope did not have a pipeline to God. Maybe parts of those old texts were simply wrong. Maybe disease and pestilence and weather were not acts of an angry God.

We did go through a renaissance and a reformation and then a scientific revolution, but we also floundered into a protracted reactionary period, a hundred plus years of religious wars, famine, pestilence, superstition and stupidity. The dramatic changes in the 1400’s did bring us literacy and art and science and a new awareness of the world as but a sphere in orbit around a star. But it also brought us the 15 and 16th century equivalents of Michael Gove, Boris Johnson, Donald Trump, and Radical Islam.

It was the invention of the printing press about 1440 that triggered that first disruption, the spread of knowledge and literacy, and with this a limitation on the powers of Popes, Princes, and demagogues. But there was a backlash and it brought on a century of pain.

Today we live within an even greater disruption, several in fact:

  • Our medicines, our science, our agricultural advances, and our industrial revolution have rendered us capable of destroying our planet. Quickly with nuclear weapons or slowly with population, deforestation and pollution.
  • The digital revolution. Faster than the printing press, information of all possible kinds is disseminated, made available throughout the world, almost instantly. And this now includes images and videos. This time around even the semi-literate are included. It is much harder today to be complacent about one’s knowledge and understanding of ourselves and the world we live in. It is much harder today to be so sure of the rightness of our lives and our place in the universe.
  • Globalization. A product of both the digital revolution, the massive increase in population, and all our other technologies. We can no longer even pretend to be isolated and protected from whatever plague is visiting a far off land or a neighbor.
  • The Internet of Things and Artificial Intelligence. The robots. We are in the process right now of creating things that are smarter than we are, can do most of our jobs, and might not obey Asimov’s first rule of robotics. Exciting and frightening times ahead.
  • Our awareness of the expanse, the complications, the weirdness of our universe is blossoming, is growing beyond our average human comprehension. Clearly our world was not created by a God in six days 4000 years ago. Would someone please explain string theory to me, and black holes, and anti-matter, and things being in two places at once; and what existed before the big bang, and does that question even make sense?

Hence the backlash. The fantasy that we can return to our whites-only pub, discuss football with the same accent, build by hand what we need, grow our potatoes and eat our pies, drink our ale in peace, and know that we are British, the truly civilized people.  The fantasy that we can rebuild a caliphate and control all around us, the women, the way we dress and eat, the way we think, regain the comfort of absolutes and certainties. The fantasy that we can retrieve small town America and go about our lives certain of our jobs, our future, our power, our exceptional place in the Universe.

It is all happening now. And to avoid a repeat of the 16th century (with global consequences this time), our leaders must understand the disruptive transition ahead of us, and the forces that would like to pull us back to an imagined time of peace, prosperity, simplicity and isolation.

We really have only two choices: Embrace and manage these disruptive changes, accept globalization, muddle through and save the planet, or let Donald and his ilk drag us into a very dark (and hot) age.